Van Vrancken Michael J, Guileyardo Joseph
Department of Pathology, Baylor University Medical Center at Dallas.
Proc (Bayl Univ Med Cent). 2012 Jul;25(3):240-2. doi: 10.1080/08998280.2012.11928838.
Complications arising from internal jugular venous catheterization are uncommon. Injury to the carotid artery is reported as one of the more common injuries. Vertebral artery injuries are rare and include pseudoaneurysm formation, arteriovenous fistulas, lacerations, and dissection with thrombus formation. Occasionally, such injuries initially go unnoticed and have the potential to cause catastrophic outcomes, leaving clinicians and families wondering what transpired. A thorough autopsy can not only help discern the cause of death, but also help to bring closure to the family. Here we present a case of an unexpected death 3 days following surgery for idiopathic scoliosis in a 17-year-old male. During the surgical procedure, a right internal jugular venous catheterization was attempted but aborted after several failed tries. Twenty-four hours after the procedure, the patient became obtunded and progressed to brain death. At autopsy, he was found to have a right transmural vertebral artery puncture wound with thrombosis leading to a massive posterior circulatory stroke.
颈内静脉置管引起的并发症并不常见。据报道，颈动脉损伤是较为常见的损伤之一。椎动脉损伤罕见，包括假性动脉瘤形成、动静脉瘘、撕裂伤以及伴有血栓形成的夹层。偶尔，此类损伤最初未被察觉，有可能导致灾难性后果，让临床医生和家属疑惑究竟发生了什么。全面的尸检不仅有助于查明死因，还能让家属释怀。在此，我们报告一例17岁男性特发性脊柱侧弯手术后3天意外死亡的病例。手术过程中，尝试进行右颈内静脉置管，但多次尝试失败后放弃。术后24小时，患者变得意识模糊，最终发展为脑死亡。尸检发现，他有一个右侧椎动脉全层穿刺伤口并伴有血栓形成，导致大面积后循环卒中。
